Does Diverticulitis Need Antibiotics?

Over the past several years, there has been an important change in how diverticulitis is treated.  This topic sentence may seem out of place on this blog which is largely a site for commentary.  This is not a site that discusses medical breakthroughs on the treatment of constipation or heartburn.  But diverticulitis does offer a commentary angle, if you will read further.

Decades of teaching and dogma have informed the medical profession that diverticulitis is a localized infection of the colon.  Diverticula, or pouches, are weak points in the large bowel.  If a tiny puncture develops at one of these sites, some stool can leak out contaminating the sterile abdominal cavity.  An infection develops which, of course, needs to be treated with antibiotics.

Indeed, for most of my medical career, every case of diverticulitis I encountered was treated with antibiotics.  In most cases, these patients recovered fully.  This observation may be Truth #1. 

Just because a patient recovers with treatment, doesn’t prove that the treatment was responsible.

If a patient is suffering from a cold, which is nearly always caused by a virus, is given antibiotics and recovers, the patient would have recovered anyway as antibiotics aren’t effective against viruses.

It can be a great challenge to leave the herd.

Several years ago, studies demonstrated that certain diverticulitis cases fully recovered without antibiotics.  These folks healed themselves.  This was a paradigm shift in diverticulitis management. We physicians have known for decades that diverticulitis could heal spontaneously since many of our patients would relate prior episodes of this illness for which they did not seek medical attention.  This observation may be Truth #2.

Diverticulitis may not be an infectious disease.

Of course, diverticulitis could still be an infection that is cured by a person’s own natural immunity, without drugs.  But it is also possible that there is no infection involved.  Perhaps, diverticulitis is simply a form of non-infectious colitis, such as Crohn’s disease or ulcerative colitis, which has no known cause.  For all of these decades, doctors simply accepted without challenge that antibiotics were necessary.

I should note that when diverticulitis is complicated or severe, experts continue to advise antibiotics.  

So, here’s the commentary you’ve been patiently waiting for.  Here is Truth #3.

Just because doctors have always done something one way, doesn’t mean it’s correct.

How many untested and unproven practices do we all do in our own lives simply be cause we’ve always done it this way?  This is not a surefire way to make progress.  All it takes is one curious person to shake things up.